Provider Demographics
NPI:1740840404
Name:MIDWEST INTEGRATED SURGEONS, PLLC
Entity type:Organization
Organization Name:MIDWEST INTEGRATED SURGEONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, CREDENTIALING AND RISK MAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-381-7431
Mailing Address - Street 1:5875 E RIVERSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4937
Mailing Address - Country:US
Mailing Address - Phone:815-381-7431
Mailing Address - Fax:
Practice Address - Street 1:5875 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4937
Practice Address - Country:US
Practice Address - Phone:815-381-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-15
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty